Anyone denied by HealthNet? - ThinnerTimes

calicowgirl · 05-19-2008, 03:34 PM

I'm waiting for approval to see the surgeon. Has anyone been denied at this point by healthnet? I don't know what my dr wrote to the insurance to get approval but I'm going to pick up a copy of the letter later today. I called HealthNet and they said approval will be based on what the letter says. She also said the requirements/hoops are different for every person based on what this letter says! To me, that seems unfair. Maybe it will turn out well for me but not the next person- or, it could turn out bad for me but good for the next.
BTW- PCP processed letter this morning- how long does it typically take to hear back?

doxielover · 05-20-2008, 10:46 AM

My PCP requested authorization for me to see the surgeon and it took about one week for approval to come back from Healthnet. After that, the surgeon's office took care of everything such as requesting referrals from Healthnet for the nutritionist, psych and lab work. All of these consults have been approved very quickly and now I'm just waiting for surgery approval. My scheduled date is June 24th. This all happened very quickly - my appointment with PCP to request a referral was on April 10th! Good luck. From what I can ascertain, if they give you the initial authorization, then you have a good chance of being approved for surgery. April in Sacramento

calicowgirl · 05-20-2008, 11:01 AM

Did you have to do the 6 month supervised diet?

doxielover · 05-20-2008, 12:27 PM

Hi Again! No, I didn't have to do a six month diet (so far). After I received the authorization to have the consult with the surgeon, I called Healthnet and asked the customer service representative what would happen next. She said that since they approved the consult, as long as the surgeon recommends surgery that I would be approved. Now, having read all of the horror stories on this site and on the other obesity related site, I'm not sure I will believe it until I have that hot little approval in my pudgy hand! You can call Healthnet and ask for the authorizations department. They will tell you if you have been approved for your consult and even give you the approval #. At first my PCP was confused and sent the request for the referral into the medical group (Sutter Independent Physicians) instead of Healthnet. My surgeons office called my PCP's office and gave them detailed instructions and the CPT Codes on how to put the letter in for the authorization. Even though it took me a week to receive the authorization in the mail, Healthnet told me that it was approved on the day it was received by them.

I hope they don't come back and say I need the diet. I would be devastated. I hope you don't have to have it either.

April in Sacramento

calicowgirl · 05-20-2008, 01:46 PM

I've heard basically the same thing- that if they approve the initial consult, you're pretty much approved for surgery too. That would be AWESOME!!! I hope we don't get hit by that diet either! I've already started it just in case (I'm in month 3) but I really wanted to have the surgery before summer's over- I don't want to wait 'til October or November!

doxielover · 05-20-2008, 02:35 PM

I'm a high school teacher, so I hope my surgery date "sticks" and I have a full 2 months to recover and learn how to eat again! Once again, good luck and I'll keep good thoughts for you!